Interviewers' notes about section M: Significant problems section

In some respects this is the most important part of the assessment. With many mental health interviews, once you have collected the answers to the fixed questions, the answers are fed into a computer that decides whether the child has a diagnosis. That's not what happens with this interview - it's experienced clinicians who make the final diagnosis, not the computer. These clinical raters review all the data (from parents, teachers and older children), and it is very helpful for them to hear about any problem areas in the child's or parent's own words. Since they can't meet the child or parent, they depend on you to type in as much verbatim information as you can. This is important for three main reasons:
 
1) It helps the raters decide whether the respondents really understood the questions. As you know, respondents may say 'Yes' or 'No' without having understood what it is that a question is getting at. Or they may exaggerate the problem, making a mountain out of molehill. Or they may go to the opposite extreme and minimise the problem - making a molehill out of a mountain! The only way the clinical raters can get round this is by reading your transcript of the problem described in the respondent's own words. This makes it much clearer whether respondents have understood or not, and whether they are exaggerating or minimising the problem
 
2) The clinical raters also depend a lot on the transcript when different people say different things about the same child, e.g. when the parent says one thing and the teacher or child say just the opposite. That makes it very difficult for the clinical raters to know whose account to believe. If the parent says that the child worries a great deal and gets very depressed and the child denies any worries or misery, who's right? You might think that the child is bound to be right - if they don't know if they are worried or sad, who does? But as you can easily imagine, there are times when children say 'No' to every question because they're being macho and don't like admitting to any problems, or because they are fed up and want to get the interview over with as soon as possible. When the clinical raters can read a detailed and convincing description of the problem in the parent's own words, that often makes it clear that they can believe the parent's account. In other cases, the reverse is true. Parents may claim that there are loads of problems, but when you ask them to describe them in their own words, they can't come up with any examples. This may make it clear that the parents are very critical of their child without much reason.
 
3) For less common disorders, the interview doesn't ask many questions, but the pattern of symptoms may be so distinctive that a clinical rater won't have any problem making a diagnosis as long as you have provided a detailed description.

For all these reasons, it is vital that you record detailed descriptions of relevant problems. Whenever you have checked a box for one of the sections in M1, you should make sure that you get answers to the corresponding open-ended questions in M2 about that section. The exact wording of the open-ended questions in M2 are only suggestions - you can use your initiative to add extra questions or explain the existing questions more clearly.

You have a choice - you can ask the open-ended questions as you go along, or you can ask them after you have finished all the sections. For example, if you tick the box for section A, then you could ask the extra questions before going on to the next section, or you could wait until you have finished all the last section. If you are asking all the open-ended questions at the end, then it is often a good idea to let the parents choose which order to take the different topics in, starting with the area that concerns them most.

Whatever you decide to do - to ask the open-ended questions as you go along, or to ask all the open-ended questions all at the end - it is usually a good idea to note down the respondents' spontaneous comments when they make them. That way, you will have less need to ask them to repeat themselves in this section. But do check before the end of the interview to make sure all questions have been covered for each area of difficulty.

When respondents provide a vague or generalized answer, then ask them for specific examples. For example, if a parent says, "he worries about everything," then ask "What sorts of worries?" Or if a teenager says, "I'm always getting into trouble," then ask "Can you tell me about a recent occasion when you got into trouble?"

Don't feel that you need to keep the answers short - extra details help the clinical raters.

The exact questions vary by section, but there are some common themes:
1.Description of the problem.
2.How often does the problem occur? - is it still a problem?
3.How severe is the problem at its worst?
4.How long has it been going on for?
5.Is the problem interfering with the child's quality of life? If so, how?
6.Where appropriate, also record what the family think the problem is due to, and what they have done about it.

If you are interviewing with a computer, you can decide whether you prefer to type the parent's or child's comments directly into the computer or to write the comments by hand in your notebook and type them in later. You can also use the notebook for recording spontaneous comments made earlier in the interview - respondents will often describe the problem in detail at the time when they are first asked about it. By the time you are ready to enter the details, they may not want to repeat themselves all over again. However, before finishing the interview, please do remember to check that you have covered all the key questions about each area of difficulty.

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Last modified : 05/09/09